Beyond stigma, there’s a role for mental health education

The 2012 Singapore Mental Health Study reported that 5.8% of the local adult population are affected by depression during their lifetime. The researchers of the study found that only a third of those with a mental illness in their lifetime had sought the help of mental health professionals (Today Online, 13 Oct 2015).

According to the same study, only 10% of the population did not subscribe to the belief that those with a mental illness “could get better if they wanted to” (The Straits Times, 6 Oct 2015). The other 90% would likely agree that “a person who has mental illness is seen as someone who is weak” (The Straits Times, “A healthy mind isn’t a given for anyone”, 10 Feb 2016) and that “depression is a failure of will” (The New York Times, “7 Thoughts From a Chronically Unhappy Person”, 21 April 2015).

But stigma is not the only reason why people who experience symptoms of depression, burnout, or anxiety do not seek professional help. Aside from prejudicial attitudes, the ability to recognise the warning signs of psychological distress remain a major barrier to mental health care. A 2015 study of 2219 Canadian employees revealed that of the participants objectively identified by the study authors to be experiencing depression, more than half “did not recognize a need to seek help” (ScienceDaily, 7 Oct 2015). But the fact of the matter is that poor mental health literacy is not unique to the community of that study. A 2014 study by IMH on local residents’ understanding of common mental disorders including depression revealed that just over half the respondents surveyed were able to accurately identify the signs and symptoms of depression (Channel News Asia, 6 Oct 2015).

Yes, we should support campaigns to reduce stigma. But, it would only be successful if it were to be accompanied by mental health education programmes which are not only about dementia (it is the only one of the top 3 mental health conditions of local concern) but which also reach the community including those in school and those in the workforce.

Did you get it right?

So you took the quiz!

Answers!

  1. TRUE. Depression is a mood state which goes well beyond temporarily feeling sad. Read up here.
  2. FALSE. Experts recognise three (not two) types of depression: major depression, dysthymia, and bipolar disorder, as described here and here.
  3. TRUE. Feelings of hopelessness and worthlessness are symptoms of depression.Other symptoms include irritability, fatigue and loss of energy, difficulties with concentration, memory, and decision-making, insomnia or not feeling rested despite adequate hours of sleep, overeating or loss of appetite, aches and pains, and headaches.
  4. TRUE. Prolonged exposure to stress does contribute to depression. Taking steps to manage one’s stress levels reduces one’s risk of depression.
  5. FALSE. Hormones which help to regulate our mood (neurotransmitters) are typically not functioning as well in someone with depression.
  6. TRUE. Family history of depression does increase one’s risk of depression. But so does experiencing a stressful life event, such as the death of a parent, child, or spouse.
  7. TRUE. According to the findings of the Singapore Mental Health Survey, depression is most common among adults. But children, adolescents, and older adults (seniors) can also have depression.
  8. FALSE. St John’s Wort is not a recommended treatment for major depression. Use caution and read the warnings about this herb.
  9. FALSE. Cognitive behavioural therapy (CBT) is an effective treatment for anxiety and depression. More information about CBT can be found here.
  10. FALSE. As this Health Xchange article notes, the Singapore Mental Health Survey found 5.8% of the population to have had depression at some point in their lifetime. That’s means over 5 in 100 persons have had depression before.
  11. FALSE. The myths and facts about depression are explained on HPB‘s website. Medication is not the only treatment option. In fact, combining medication with CBT is effective in treating mild or moderate depression.
  12. FALSE. The risk for depression is higher for women than men.
  13. TRUE. Individuals with depression are taught mindfulness techniques to help make treatments like CBT and/or medication more effective.
  14. TRUE. It’s easy to find out more about depression: NIH has fact sheets in many languages including Chinese.
  15. TRUE. Depression was featured on the local TV programme Body and Soul in 2014 (not 2011). Gotcha. But you can watch it again on XInMSN!
  16. FALSE. Loss of interest in things which once used to be of interest is another sign of depression. Individuals with depression may have difficulty “getting out of bed“.They may not be motivated to participate in sports or to continue their hobbies (though some have used creative outlets to express themselves — read more in this post on the NY Times blog on photography and mental illness).

How many answers did you get right?

Above 12:   Congratulations! Get more news here about a study which piloted a simple waiting room test for depression, and the latest research on how those who display neurotic behaviours are more likely to suffer from depression and anxiety.

8-11:           Well done! You can stay up-to-date by reading about new research developments on medications and therapies for depression here.

Below 8:     Good attempt! You can find out about how depression affects your performance at work…and how you can look after yourself to stay well. Keep it up!

Know the facts about depression? Take this quiz!

puzzle

You’d have heard all about depression by now. Specifically, a major depressive illness. About the treatments for depression. The facts about depression. The link between depression and comedy. About the 2014 study (here’s the science) about comedians and their personality traits which lend themselves to comedy but also have similarities to traits in people with psychosis (fact sheet about psychosis here). That significant life events can play an important role. That depression is not merely sadness. That work and cycling can be coping strategies.

So you should have no difficulties answering these questions. True or False?

  1. Depression is a mood state which goes well beyond temporarily feeling sad.
  2. There are two types of depression.
  3. Feelings of hopelessness and worthlessness are symptoms of depression.
  4. Chronic stress can lead to depression.
  5. Mood-regulating hormones are likely to be functioning well for someone who has with depression.
  6. Family history of depression increases one’s risk of depression.
  7. Depression is most common among those aged 18 to 40 years.
  8. St John’s Wort is not a recommended treatment for major depression.
  9. Cognitive behavioural therapy (CBT) is effective for treating anxiety but not depression.
  10. Every 4 in 100 Singapore residents have had depression in their lifetime.
  11. Medication is the best treatment option if one has mild/moderate depression.
  12. The risk for depression for women is equally high as it is for men.
  13. Mindfulness is a technique which is useful in the treatment of depression.
  14. It’s easy to find out about depression in other languages (e.g., Chinese).
  15. Depression was featured on the local TV programme Body and Soul in 2011.
  16. Someone with depression is likely to maintain an interest in sports or hobbies.

Find the answers from these resources: 1) NAMI, 2) ADAA, 3) NIHM, 4) Black Dog Institute (BDI), 5) Harvard Medical, 6) standford.edu, 7) Singapore Mental Health Survey, 8) Medline Plus, 9) RCPsych, 10) Health Xchange, 11) HPB or nice.org.uk, 12) umn.edu 13) BDI Fact Sheet, 14) NIH, 15) XInMSN, 16) Health Xchange.

FInd out the answers at the end of the week!

Clothes — The long and short of it all

We already know about the benefits of exercise. Exercise increases life satisfaction, improves mood, and reduces feelings of depression and anxiety (read this for the full story). Blah blah blah…yes, exercise makes us feel better. And it plays an important role in helping us maintain our self-worth (here’s the evidence for that claim).

There are other things which raise self-esteem: positive self-appraisal (what’s that?) and self-awareness (how can I achieve that?). As with exercise, we see what we need to do, but the legs, arms, and mind aren’t particularly motivated to get us there. Gadgets or no gadgets.

There is however a speedier solution to boosting one’s confidence (note: it is of course easy once you know how): It’s about what you wear.

Clothes make the dog!

There is evidence that how we feel affects what we wear. In a 2012 study by Fletcher and Pine, women reported themselves more likely to wear baggy clothing and jeans when experiencing a low mood (e.g., feelings of depression) and more likely to wear their favourite dress when feeling happy.

There’s evidence that what you wear affects how you behave. A study showed that putting on a doctor’s white coat made participants perform better on a cognitive task (here’s that study explained).

And there’s evidence that what you wear affects how others perceive you. A study found that participants rated someone in a tailored suit as more successful and confident than the same person in a off-the-peg version. Findings from yet another study revealed that a subtle change in the length of the skirt — whether it was just above the knee of just below the knee — influenced how study participants viewed the person wearing the clothes. In the condition where the person was introduced as a “senior manager”, participants judged her to be more intelligent, confident, and responsible with the longer than shorter skirt. Turn these findings around, and they actually tell us that we make snap judgements about others (and ourselves) based on what they (or what we) wear.

And a 2013 poll of 100 respondents found that 2 in 5 women believed that wearing red increased their professional confidence. Clearly, we know that clothes do affect how we feel about ourselves, as demonstrated in this guide on How to dress for success by Real Simple (look here for tips on dressing well for men).

So what clothes make us feel better about ourselves? There’s really only one thing to know and that is to wear clothes that fit you! It’s important to put on clothes which fit, not clothes that are in fashion right now. Real Simple has a guide for different body shapes, while BBC programme What Not To Wear offers tips on making the most of our assets. Wearing a pencil skirt that stops exactly at the knee (not an inch above it or an inch below it) or jeans which are bootcut or skinny depending on your body shape is half the battle won.

The other half is what you do with that extra confidence you’ve gained.

Clothes make the man. Naked people have little or no influence on society.
~Mark Twain

 

4 Things Every Woman Should Do And Know

It appears that we currently lack information about the effects of medications and dosage recommendations which are appropriate for women (see this recent report from HealthDay News). But there are many other aspects of women’s mental and physical health for which much information is available, but for which awareness is often lacking. With International Women’s Day just a day away, we propose four things you can do to get up to speed this weekend:

1. Build your professional and social network

Research supports the role of a social network for mental wellbeing at the workplace and at home. The New Zealand Chamber of Commerce has an “Inspiring Change – International Women’s Day 2014” breakfast networking event aimed at inspiring personal and career growth held at Raffles Hotel on Monday, 10 March 2014, while the Singapore Committee for UN Women has a “I am fabulous and I inspire change” cocktail networking event at the Grand Park Orchard on March 6th. Those seeking inspiration can join a sharing session with Dr Aline Wong as part of the “Be inspired, create positive change” campaign by WINGS.

All this might be a bit much for the person who doesn’t really like talking to strangers. Joining an interest group like the Nature Society will open doors to opportunities for making new friends. Gym membership, signing up for a language, dance, painting, or pottery class, and volunteering with animal shelters will also offer more opportunities to meet like-minded individuals. Here’s a list to help you get started (Expat Living also has suggestions).

2. Make time for yourself

Self-care is the fancy way of saying that we need to look after ourselves in order to stay psychologically healthy. This includes the running, dog walking, park connector cycling, spinning, kick-boxing, trampolining, healthy eating, and spa-pampering that we do every week. It is the mindfulness that everyone’s thinking about these days (“How to fight stress? It’s all in the mind“, Straits Times, 3 March 2014). It’s also the family meals and kite-flying picnics that we’ve been having with our loved ones.

And if you’re not been doing any of these, there’s no time like the present. The iLight festival at Marina Bay (Timeout has the scoop) starts this Friday 7 March 2014, while the Mosaic Music Festival celebrates its 10th year, running for a fortnight at the Esplanade starting 7 March 2014. Looking forward, Shylock, Portia and other Venetians transform Fort Canning for its annual picnic event in April: Shakepeare in the Park.

Clawing back time from work responsibilities may however be a job of its own—it may be time to put your assertiveness skills to the test. Learning to say no is a skill that takes practice. In the meantime, some girlie and parenting life hacks may come in useful. So are these useful links, particularly if you’re new to Singapore.

3. Be aware

Aware celebrates International Women’s Day with a Facebook campaign to promote gender equality. Recent media attention also puts the spotlight on workplace bullying (“Facing up to bullies at the workplace“, Straits TImes, 24 Feb 2014) and ensuing legislation (“New harrassment law could be enacted soon in Singapore“, CNA, 26 Feb 2014; “Stalking now an offence under new anti-harrassment bill“, Today, 4 March 2014).

The impact of bullying on employee mental wellbeing is well documented: “The Richie Incognito Case: Workplace Bullying or Just ‘Locker Room” Culture?‘”, APA, 21 Nov 2013, Workplace Bullying: Applying Psychological Torture at Work“, “Bullying in the workplace“, Psychology Today. A zero-tolerance policy at the workplace is key to helping employees maintain their mental wellbeing, as well as sustain employee engagement and productivity. It helps too, if employees recognise bullying behaviours and know the steps to take to protect themselves from the negative effects of bullying.

4. Knowledge is power 

Someone who collapses after running a marathon almost always seems to be a man (e.g., 2XU Compression Run). At least that’s what we get from the news. But statistics show that “women are just as prone to heart disease” as men (Straits Times, 7 May 2013; read this article by the Singapore Heart Foundation). Furthermore, women who experience high levels of stress are reported to be particularly vulnerable. Breast and colorectal cancers are among the top cancers for women in Singapore (based on figures from the Singapore Cancer Registry) but there is evidence to suggest that these and diabetes are preventable with fruits, veggies, whole grains, and an active lifestyle.

Newspaper reports about men with depression appear more often than those about women with depression, potentially fueling our use of the availability heuristic. As a result, we may think that depressive illnesses are more frequent in men than women. In fact, it is the opposite (here’s why); moreover, it’s widely acknowledged that mental illnesses affect women differently from men (the US National Institutes of Health has useful fact sheets).

You can do something about it. Even if you’re only reading about it (e.g., from the US National Women’s Health Resource Center; Women’s Health (Department of Health and Human Services); US NIH’s Women’s Health Resources). It’s a good start!

Postscript. There is local funding to promote women’s health at the workplace, though it does not quite provide for all the items on this wish list. Enjoy!

Good intentions

New Year resolutions

It’s that time of year again when we think about the things we want to accomplish this year. A week ago, the opinion piece that that was published in the New York Times, “Fighting to kick the habit”, highlights the struggle of one person (one rather famous person). Having the facts about addictions is one thing. Overcoming the barriers to recovery is another.

It may not be addictive behaviours that we’re trying to set straight this year. We may just simply be trying to keep our list of new year resolutions simple and accomplish a few simpler things. This year, we will:

1. Manage our time efficiently. It’s on our perennial wish list. We want to spend time with family and friends. And that means being efficient at work (and household chores, groceries, errands, school runs, and the list goes on). Prioritizing the things on our to-do list is one way to go. Exercising the delicate power of delegation is another. Communicating effectively with your boss and team as well as your family at home, and using technology to our advantage (Life Hacks, time-saving tips, the Real Simple stuff) are also important strategies which are not to be underestimated. Go, get on with it!

2. Live healthily. A two-week plan (see Dr Oz’s) for achieving a healthy body mass index (BMI) seems short-term. But it’s not. It’s a small step we can take on the road to better cholesterol levels, lower blood pressure, and better readings of blood glucose. The two-week plan won’t get us there instantly. But two weeks is plenty for retraining your body to achieve greater satiety during meals (that is attaining a feeling of fullness so that we don’t crave nutrient-free caloric-full foods ten minutes after lunch or breakfast; tips here and here). And it’s certainly plenty of time for scheduling in more activity into your routine (and exercise will certainly help with achieving number #1). Falling off the wagon today doesn’t mean we need to fall off it the rest of the week. As the saying goes, try. And try again.

3. Do something about it. We want to be more assertive at work. Shop less. Save more. Sort out the cupboard for which its contents will unravel and cover the floor when we open the door (it might help the next time we’re tempted to get another one of those things we already have five of; tips here and here). Get help with psychological issues. Spend less time with non-hostile acquaintances who don’t seem to appreciate us (practical advice here). Have fewer arguments at home (helpful tips here). In any case, it’s a good time to do something about it.

And anyway, there’s a second new year for our resolutions (akan datang)!

“Let’s find out more about mental illness”

Mental health resources

Yes, let’s. The article “Let’s find out more about mental illness” published in Straits Times, 16 Nov 2013, talks about childhood mental health disorders, and specifically, depression, anxiety, and schizophrenia.

It’s timely, given that understanding about mood and anxiety disorders involving adults tends to be poor, let alone mental health disorders involving children and adolescents. And it’s a good time as any to talk about mental health disorders, especially in the light of recent news reports involving individuals with depression.

But what is it that we understand about mental health disorders? From the resources made available to various organizations dealing with mental health issues, quite a lot actually.

But first, maybe we should know at least a few things worth knowing:

1. Stigma is everywhere, not just in Singapore.

That there is local stigma about seeking help for mental health disorders is not surprising.

But these are ubiquitous issues, relevant to other communities such as those in UK (“Understanding anxiety and mental health stigma”, The Guardian, 27 Sep 2013), Australia (“Mental health stigma still affecting Australian workers, with research showing 4 in 10 hide depression from their employers”, ABC, 12 Nov 2013), Canada (“Montrealers demonstrate to end mental health stigma”, CBC, 20 Oct 2013), Hong Kong (“First mental health web radio in Hong Kong raises the community’s awareness on mental illness and mental health”, UHK, 15 Nov 2013), and Taiwan (“Society must confront mental health stigma, redefine success”, The China Post, 3 June 2013).

We may not have progressed very far (“S’poreans fear mental patients, study finds”, Straits Times, 29 Oct 2007), but at least we’re increasingly cognizant of the issues and are adding to facts not fiction.

This Huffington Post article provides 3 helpful suggestions for how you and I can make a difference. The UK campaign which started in 2009 to end mental health discrimination at their www.time-to-change.org.uk offers useful tips on how to talk about mental health issues.

2. There are resources out there for the public.

3. There’s information about mental health disorders in children and adolescents.

4. Other resources include information about developmental disorders.

5. We can always do more.

A 2012 report in the Singapore Annals Academy of Medicine did not investigate whether their stratified sample of 6616 respondents, among whom 12% met the criteria for mood, anxiety, or alcohol use disorders but less than a third had sought professional help, used the internet to find out more about mental health disorders. Given that the same report acknowledges 80% or more of the local population aged 49 years and below (and 40% of those aged 50 to 59 years) has internet access, there’s much scope for accurate information about mental health to be provided on an online platform. This BBC Wales health report presents possibilities, while the UK Child and Maternal Health Intelligence Network offers ideas via a Tackling Stigma Toolkit. There are always more things that can be done. Something we can work towards perhaps?